title: Altered molecular repertoire of immune system by renal dysfunction in the elderly: is prediction and targeted prevention in the horizon?
abstract: BACKGROUND
  Patients on chronic hemodialysis (HD) have impaired cellular and humoral immunity. The percentage of elderly people among the total population in Taiwan is increasing dramatically, and HD is the primary alternative for renal replacement therapy when renal function declines. Activated vitamin D is widely used in HD patients with secondary hyperparathyroidism (SHPT) and is a well-known immunomodulatory agent. Personalized medicine and integrative medical approach has been a trend in current clinical practice. Can we improve their immune function using vitamin D in spite of the mineral aspect? Here, we investigated the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and T cell differentiation in chronic HD patients.
  
  
  METHODS
  Forty patients with chronic HD were enrolled. HD patients with SHPT had been treated with activated vitamin D for 3 months. Peripheral blood mononuclear cells obtained from the patients were cultured and stimulated by mitogens, and T cells were analyzed by flow cytometry. Serum 25(OH)D levels were detected by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  The incidence of T cell differentiation to the T helper cell (Th)2 subtype was more prevalent in the elderly group than in the controls (p = 0.001). Th2 differentiation was also correlated with age (p = 0.004) and serum 25(OH)D levels (p < 0.05). After treated with activated vitamin D, the level of Th1 cytokines decreased while the Th2 cytokine level increased in the sera (p < 0.05). The T cell differentiation tended toward the Th2 subtype (p = 0.027) after treatment of activated vitamin D in SHPT patients.
  
  
  CONCLUSIONS
  These results demonstrated that Th2 differentiation is correlated with age and the serum 25(OH)D level of patients. Treatment with activated vitamin D influenced T cell differentiation and cytokine expression in SHPT patients. Taking vitamin D is the possible prediction and targeted treatment in the immune dysfunction in chronic HD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital, Yong-He Branch, Taipei 234, Taiwan.
authors.forename: Cheng-Lin
authors.initials: CL
authors.lastname: Lang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital & School of Medicine, Fu-Jen Catholic University, New Taipei City 231, Taiwan.
authors.forename: Min-Hui
authors.initials: MH
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei 10048, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei 10048, Taiwan.
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital & School of Medicine, Fu-Jen Catholic University, New Taipei City 231, Taiwan.
authors.forename: Kuo-Cheng
authors.initials: KC
authors.lastname: Lu
keywords: Age; Hemodialysis; Immunosenescence; Integrative medical approach; T cell differentiation; Target prevention; Vitamin D